What has gone wrong with Lantus adjustments

I thought I was almost there getting perfect BGs after a number of days carb free test meals to get the split Lantus dose correct. 6th April was the almost perfect day achieved and then the action following a low sleep BG of 4.8 at 03:45 and the easter dinner with incorrectly estimated CPs on the 8th April things went wrong.

After the number of days of carb free meals got to Lantus split dose of 6 with breakfast and 5 with evening meal.
To deal with the BG 4.8 overnight, I reduced the evening BI from 5 to 4 and increased the morning BI from 6 to 7.
Then the Easter meal got the starter estimate wrong by about 1.5 CPs. Felt bad with BG @ 14.3 during the meal. a shot of vodka with a glass of wine might also have been a factor. But since then BGs have been high all the time

Please have a look at the BG diary extract (my earlier post shows how I got to BI doses of 6 and 5)

I probably need to reinstate the BI dose of 5 in the evening - but presumably risk overnight BG going close to 4.5 or lower ( I do feel BG going below 5). So do I go back to 6 and 5 instead of 7 and 4? Or go to 8 and 4?

Pretty good results on the 6 and 4 doses, your holding steady, all be it going slightly higher by the time your evening BI dose is due, but your AM dose may be running out/low by then, so to be expected...........

I see your correcting with half units of insulin, you mat feel this is needed, but my opinion is its not........

on the 8th at 21:05 you were 10.8, this should of been corrected with 2 units, if your following the rule 1 units drops 2-3mmol/l.....later that evening wrong carb count as you day messed up those results.....also you split your dose here for whatever reason [high fat content etc...] if it was the high fat content, the glucose release from the food may have continued well into the night and effected the next morning....

Alcohol usually drops the blood sugar by inhibiting the normal functions of the liver, you could of went low, then rebounded, but I don't suspect this in your case, its more likely delayed absorption, or in fact your BI.........you need more basal tests to confirm the 4 dose, it worked 2 days in a row, all be it, without carbs.........

I would remain at 7 and 4 and continue testing, the results of your basal testing so far are positive, I think the problem lies with your insulin/carb ratios and your corrections, in that you need that little bit more to get you on target. Bear in mind the higher you are, the less 1 unit will drop you...........

Thanks James - will stick with 7 and 4. You see I did not want to get to recalibrarting my QA:CP ratios until I got the BI perfectly right -which does mean extending the carb free test period !

The 8th March evening meal was over an extended period and I did not know what was going to come next so that is why I split the QA dose for starter and main meal. The 14.3 BG reading at 21:55 was probably due to beetroot soup which had 1 CP which I did not count because thinking it was just a vegetable and also there was probably half an apple in one of the starters so I was 1.5 CPs out in my estimate but I think the beetroot soup was fast acting carbs!

Yes I have been doing half unit corrections and that was the reason I thought I needed the Demi pen as I believe I am senstitive to insulin. I could have had 1 QA unit this morning as correction instead of half. But yesterday's lunch time correction of 1 QA unit with BG at 9.3 should have been adequate. This was day 2 with BI @7 in the morning so any delay in the increase in Lantus should have settled down by then.

I do not want to introduce CPs yet as that would confuse the matter and make it difficult to establish what the BI should be. The trouble is that any change to BI takes 2-3 days to settle down.

[PS had the wrong time in the BG Diary for the BG 14.3, it was 50 minutes after the start of the meal - now corrected as 21:55]

One of the many benefits of Levemir, however not everyone gets on with it I suppose...........

When you corrected your 9.3 with 1 unit that should of been sufficient, however you forgot about the possibility of your AM BI dose running low/out by the time 19.29 came.....

Remember you only have to do carb free for the night time testing, once your confident the dose is right, then move on to daytime basal testing with no carbs..............you may be fine with having low/no carbs, but I know I wouldn't be, I would definitely be producing ketones.....just as long as you know you don't need to be so strict on yourself. I realize getting a clear a picture as possible is important though.....

you might be sensitive to insulin, so don't take my word as gospel................its just seems from the results that the corrections are not enough........

Keep up the good work..................

Thanks James for all the advice. Noticed an error in the time for the measurement during the evening meal of the 8th April. Corrected now. I will tackle evening BI testing separately from the morning one. I wonder when Saofi will admit that Lantus is not a 1-dose 24 hour insulin !!!

Hi Simon,
Just a wee thought, how are your injection sites as I see from your results that you more often than not are using the same site (Right Thigh). If you have been using the same site for a while this can also affect the absorption rates of your QA hence rotating sites seems to help with this. Just a thought as it may also help explain some of your results?

Cheers,
Anele.

Hi Anele

I do worry about the injection sites but I think they are ok.

I am having the Lantus in the left thigh and the novarapid in the right thigh. I do try to move the injection point but do not always remember where exactly I injected last.

With the carb free week there has been less novorapid so hopefully thigh had some rest.

I am avoiding belly area because I have a hernia from previous operations and I am waiting for an op for it to be repaired. Not sure what happens after I have the stratus mesh inserted there but for now I am keeping away from the tummy.

Strange results are baffling. There is evidence to suggest that higher insulin doses result in higher BG levels, I will start separate thread on this and do some researching first. Might explain why some people need loads of insulin compared to others - the more you inject the body gets moved to higher levels needing more insulin ... may be there are thresholds. Anyway will leave this crazy idea to another thread,

Simon Ajina said:
Thanks James for all the advice. Noticed an error in the time for the measurement during the evening meal of the 8th April. Corrected now. I will tackle evening BI testing separately from the morning one. I wonder when Saofi will admit that Lantus is not a 1-dose 24 hour insulin !!!

Thanks Roger. Carbs are back this morning. I will give it a rest for a while. Has been going wrong in past few days since increasing Lantus morning dose from 6 to 7 and then to 8. So this morning decided to regress my change and taking back my dose levels to those I had on the 6th April and back to normal eating with carbs.

I am searching for posts on the internet of people having BG levels go up after increasing Lantus slightly. So far I have come across statements like:
- The Solostar pen is very inaccurate at low doses
- Liver bounce back (compensating for low BG) may be occurring at higher level than hypos.

The morning I increased my Lantus from 7 to 8 I got a lunch BG of 15.3. Repeated the test and got 13.3. There was no hypo between breakfast and lunch. Before this when Lantus was increased from 6 to 7 had days after with higher levels of BGs.

So now reverted back the Lantus level and back to eating CPs.

If you are anything like the rest of us, your Lantus BI changes will take 3 days to have any effect. Please allow time before making any further adjustments.
I have confused myself by making too rapid changes in the past.
Regards
Garry